Author’s note: opinions and articles on neurodiversity often generate a great deal of controversy due to how intricately linked the concept is to self-identity. It is not uncommon for people to misinterpret, jump to conclusions, and feel upset at what appears to dismiss or invalidate their experiences. To that note, the author encourages you, the reader, to read this article in its entirety before arriving at your own evaluation.
Imagine this: You’re out with your friends. Just 4 of you. Chances are 1 of you would think that you have Attention-Deficit/Hyperactivity Disorder (ADHD). That was what a recent survey conducted by The Ohio State University found – that 25% of the 1000 adults surveyed suspected that they have undiagnosed ADHD! Now contrast this to global estimates for the prevalence of ADHD:
- In children aged 3-12 years old: 7.6% have ADHD (Salari et al., 2023)
- In adolescents aged 12-18 years old: 5.6% have ADHD (Salari et al., 2023)
- In adults aged 18 and above: 6.76% have ADHD (Song et al., 2021)
Given the relative stability of the prevalence of ADHD across the lifespan (between 5%-7.6%), what the survey data suggests is that the number of people who think they have ADHD far exceeds the actual likelihood that they do by 3-5 times! What exactly might be going on?
Social & media
The elephant in the room would be the role social media played in perpetuating the myths, stereotypes, and false impressions relating to ADHD. In fact, a recent study done by the team at the University of British Columbia found that the vast majority of claims made on the most popular #ADHD TikTok videos are false. But more than that, social media merely a tool that people use to achieve a(n often unconscious) purpose. ADHD, as a label, serves a (sometimes problematic) social function. In fact, to a great many people, barring those who are truly neurodivergent, (self-)identifying as ADHD serves to emancipate them from liabilities and responsibilities, or as a means to construct a social identity (Honkasilta & Koutsoklenis, 2022). Meerman and colleagues (2022) discussed how people may solicit an ADHD diagnosis for “(financial) resources and healthcare services“, but also for “ontological certainty toward their identity and challenges in life or are in search of an “excuse” for their behavior.” (p.10)
It is important to emphasize at this juncture that ADHD is indeed a real and valid condition. However, the sheer discrepancy between the number of people who will qualify for a diagnosis, and the number of people who think that they have ADHD (and perhaps self-diagnose or self-identify as having) cannot be ignored.
Mis- and over-diagnosing
Beyond the chatter on social media, what is more worrying is the finding from a recent study conducted using the 2023 National Wellbeing Survey (London et al., 2025). The authors found that 14% of working adults aged 18-64 years old reported being diagnosed with ADHD by a healthcare professional. This is significantly higher than the estimated 4.25% in 2012; a greater than threefold increase over the span of a decade! Even if we are to accept that self-diagnosis is inherently unreliable and flawed, how do we account for this phenomenon since these people were supposedly diagnosed by a healthcare professional?
The crux of the issue perhaps lies in the fact that adult ADHD evaluation is extremely varied and non-standardized, an issue that was discussed in our previous Blue. article. As such, clinicians without the relevant expertise may employ erroneous evaluation protocols and are highly prone to misdiagnosis, especially since “more commonly, symptoms represent non-impairing cognitive fluctuations, a comorbid disorder, or the cognitive effects of substance use. False positive late-onset ADHD cases are common without careful assessment.” (Sibley et al., 2019) In fact, adult ADHD assessment is so problematic that the UK Adult ADHD Network (UKAAN) advocated for a “quality framework for adult ADHD assessments – the Adult ADHD Assessment Quality Assurance Standard (AQAS)” (Adamou et al., 2024) hoping to codify what good assessments entail. Accordingly,
- “An accurate diagnosis of adult ADHD requires a skilled and knowledgeable practitioner. One of the necessary skills is knowing when not to make a diagnosis, something that requires a sound understanding of both ADHD, and other mental, neurodevelopmental, and sometimes physical health conditions.“
- “Assessment of adult ADHD should not be seen in isolation but as only one component of a full psychiatric and neurodevelopmental review.“
- “The assessor must be familiar with autism spectrum, mood/bipolar, personality and substance use disorders, and other comorbidities and differential diagnoses. It is also important to consider physical comorbidity, particularly conditions that have a bearing on prescribing medication for ADHD or may cause symptoms resembling those of ADHD.“
Essentially, it is worth noting that like assessing for autism, ADHD assessment is a process that have a high barrier to entry, and should ideally only be conducted by clinicians with the relevant training and expertise.
What constitutes good diagnostic practice?
According to a consensus statement published by the World Federation of ADHD (Faraone et al., 2021), “ADHD can only be diagnosed by a licensed clinician who interviews the parent or caregiver and/or patient to document criteria for the disorder. It cannot (emphasis mine) be diagnosed by rating scales alone, neuropsychological tests, or methods for imaging the brain.” As such,
- Diagnoses made solely based on psychological testing? – Inappropriate
- Diagnoses made solely based on computerised test of performance (CPT)? – Inappropriate
- Diagnoses made solely based on symptom report tools and rating scales such as the Conners Adult ADHD Rating Scale (CAARS)? – Inappropriate
- Diagnoses made by electroencephalogram (EEG), brain scans, or eye movement tracking? – Inappropriate
Instead, appropriate and comprehensive diagnostic protocols (Adamou et al., 2024) should include:
- Full psychiatric history
- Neurodevelopmental evaluation
- Past medical history for consideration of differentials
- Comprehensive interview of life/personal history
- Semi-structured clinical interview of symptoms (e.g. using the DIVA-5)
- Corroborative history
- Active and intentional consideration of differential diagnoses
While neuropsychological tests do not and should not form the primary basis for diagnosis, it can be used to determine ‘potential’, which is an assumed baseline of how a person ought to function given their cognitive abilities, when evaluating for dysfunction or impairment (Faraone et al., 2024). Other possible tools that could support measurement of dysfunction include the Everyday Life Attention Scale (ELAS; Groen et al., 2019).
Adult ADHD: inherent or acquired?
Beyond inaccurate self-labelling and erroneous clinical diagnostic processes, perhaps the final piece of the story wrestles with the notion of what exactly is adult ADHD, and if it is a collection of symptoms that could be acquired through problematic environmental exposure. A recent study (Alfonso et al., 2024) published in the Journal of Attentional Disorders found that greater childhood adverse experiences (ACEs) were related to greater endorsement of childhood and adulthood inattentive, impulsive, and hyperactive symptoms. While the authors discussed the possibility that some purported ADHD symptoms could potentially be “misattribution of attention problems due to childhood adversity/traumatic stress“, this nonetheless begets the question of what exactly is adult ADHD. The findings by Alfonso and colleagues echoed an earlier study by Brown et al. (2017). Based on a sample size of 76,227 children, the authors concluded that “the presence of 1 or more ACEs increases the likelihood of having a parent report an ADHD diagnosis and moderate to severe ADHD.” In fact, they had found “associations between parent-reported ADHD and socioeconomic hardship, parent/guardian divorce, familial mental illness, neighborhood violence, and familial incarceration,” further suggesting that perhaps ADHD has a significant social and environmental undertone.
To further muddy the waters, a recent commentary (2023) by Professor Gordon Parker posited that digital media and technological consumption might be an etiological factor (i.e. cause) of ADHD. It therefore begs the question of whether the sudden and drastic increase in adult ADHD prevalence could potentially be due to how we on the whole are increasingly consuming more digital content that rewards [1] short attention, and [2] high novelty seeking behaviour. Think of all that ‘shorts’, ‘reels’, and ‘story’ content that are constantly featured on our social media apps. Could that possibly, over an extended period of time, contribute to the rewiring of our neural circuitry? Perhaps that’s a question that can only be answered in time as more research into the area is done. However, before anyone raises their pitchfork and torches, it is worth nothing that there is some preliminary evidence that digital media does directly influence the subsequent development of ADHD symptoms (Thorell et al., 2022). Specifically, the ‘scan and shift’ hypothesis suggests that “that the fast pace of digital media may encourage using attentional resources to quickly scan and shift, making it more difficult to later engage in tasks requiring sustained attention“. Additionally, it is hypothesized that “children who have high levels of screen time have a harder time paying attention to less interesting activities, possibly because they lose the ability to regulate their attention internally after having gotten used to external regulation through digital media“.
Given the above, perhaps the concept of what ADHD is might be better described by Banaschewski and colleagues (2024):
“This highlights that ADHD cannot be comprehensively understood as a natural entity confined within the individual, but rather as a phenomenon that arises within the context of external demands. Moreover, the concept of impairment attributed to ADHD is not inherent but is rather socially constructed, context-dependent, and contingent upon the environment. If ADHD were conceptualized and taught as a social construct, embracing a holistic approach that avoids reducing individuals solely to ADHD, recognizing the profound implications of diagnosis on identity development, and rejecting a reductionist perspective that focuses on isolated symptoms or behaviors, while also critically considering societal factors such as the pressure to perform, it could be hypothesized that both the diagnosis and treatment of ADHD would undergo a transformative paradigm shift.“
Conclusion
ADHD is a real condition that affects roughly 5-7% of the population. Those are numbers that are based on the best available evidence at this present moment. As such, there is reason to believe that the recent drastic increase in diagnoses (whether self- or clinician-identified) could potentially be attributed to trends in social identity formation, or more worryingly, misdiagnoses by inappropriately trained healthcare professionals. However, a third and more sinister reason is plausible – that perhaps the socio-environmental factors, such as adverse childhood events, poverty, environmental risk factors, and excessive media consumption in the digital era, are putting forth an unprecedented environmental pressure that quite directly modifies our neurological pathways, leading to an acquired ADHD condition. Until more research is conducted into the area, it remains to be seen what might underlie this recent and sudden explosion in what we call Adult ADHD.
Eugene
Blue. Psychological Services 